Postoperative Pelvic MRI of Anorectal Malformations

Eltomey, Mohamed Adel; Donnelly, Lane F.; Emery, Kathleen H.; Levitt, Marc A.; Peña, Alberto

doi:10.2214/ajr.07.3773

Cited by 30 publications

(17 citation statements)

References 8 publications

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“…The importance of siting the pulled-through rectum accurately and symmetrically in the sphincter ani at primary operation is stressed, as fecal incontinence can occur with asymmetrical placement. In contrast to many studies, 13 our finding showed 33. 3% of the patients had their pulled-through rectum sited away from the center, but analysis showed that this does not have significant impact on the outcome of the patients clinically.…”

Section: Statisticscontrasting

confidence: 99%

Magnetic Resonance Evaluation of Anorectal Malformation Cases Treated by Posterior Sagittal Anorectoplasty

Bhuyan¹,

Agarwal²,

Khongsi³

et al. 2015

jemds

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OBJECTIVES:Pelvic MRI is a useful tool for assessing patients with anorectal malformations before and after operation. The images obtained after PSARP can be reviewed for quality and shape of the sphincter muscle, position of the rectum, shape of the sacrum, and associated pelvic abnormalities related to the initial operation. These were then correlated with the clinical status of the patient during follow-up after colostomy closure. MATERIALS AND METHODS: Twenty six male patients with intermediate or high anorectal malformation were included in the study between January 2012 to December 2013. The findings thus obtained in the MRI were correlated clinically with the Kelley's scoring system. RESULTS: A total of 26 post-PSARP patients were included in the study. Eighteen of them were also selected for clinical correlation after colostomy closure. According to MRI findings, 2 patients had good degree of development of the pelvic floor muscles, 11 of them had fair amount of muscles and the rest 13 of them had significantly thinned out muscles. Four patients showed well-developed external sphincter muscle, 15 of them were having fair degree of development and in the rest 7 of them it was poorly-developed. Our study also showed that only 3 patients were showing symmetrical development of the sphincter complex whereas in the rest 23 of them it was asymmetrical. Eighteen patients had centrally-placed pulled-through rectum, whereas in the rest 8 of them the colon was located away from the center of the sphincter complex. Sixteen patients had mesenteric fat inadvertently pulled along with the bowel during PSARP; and in this same study, 58% of our patients were also having associated anomalies detected by MRI. On clinical correlation, it was found that external sphincter muscle and fat interposition play an important role in the overall clinical status of the patients after colostomy closure. CONCLUSION: Pelvic MRI is a useful tool for assessment of anorectal malformation after PSARP. Our study shows that development of the external sphincter muscle and the presence of mesenteric fat interposition has significant impact on the overall clinical status of the patient; however, other factors like operative technique and muscle innervations may also play important role in the overall continence of the patients.

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Section: Statisticscontrasting

confidence: 99%

Magnetic Resonance Evaluation of Anorectal Malformation Cases Treated by Posterior Sagittal Anorectoplasty

Bhuyan¹,

Agarwal²,

Khongsi³

et al. 2015

jemds

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“…The value is considered significant, when 'P" value is less than or equal to 0.05. (9) 4 (44.4%) 5 (55.56%) 6 (66.6%) 3 (33.33%) Absent (12) 12 0 12 0 Soiling Present (5) 0 5 (100%) 4 (80%) 1 (20%) Absent (16) 14 2 16 0 Constipation Present (7) 3 (42.86%) 4 (57.14%) 4 (57.14%) 3 (42.86%) Absent (14) 13 1 14 0 Out of these 294 patients twenty-one patients who had complained of bowel dysfunctions like soiling, constipation and bowel incontinence were included in the study. Remaining 273 cases were excluded because of normal bowel habit in 271 cases, one case having permanent faecal diversion and one case re do pull through.…”

Section: Discussionmentioning

confidence: 99%

Functional Co-Relation Between Operated Cases of Anorectal Malformation and Post-Operative Pelvic Mri

Mohanty¹,

Parida²,

Mohanty³

et al. 2019

jemds

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BACKGROUND The treatment of ARM has evolved from a simple cutback/translocation anoplasty to abdominoperineal pull through, its modification, to the currently practiced procedure of posterior sagittal anorectoplasty (PSARP). We wanted to evaluate the relation of the type of anorectal malformation with surgical procedure done, and also the functional outcome with post-operative pelvic MRI. METHODS A cross sectional study was undertaken at the Department of Paediatric Surgery, a tertiary care hospital from October 2013 to September 2015. Children suffering from ARM who have completed all stages of surgery with regular follow up who are at least 3 years old and still having having bowel dysfunction were included in the study. RESULTS Twenty-one patients were included in this study; sex ratio was 3.2:1 (M:F). 16 male patients having high and intermediate ARM underwent PSARP or Abdomino-Perineal pull through procedure. 5 female patients having (Anovestibular/ rectovestibular/anteriorly placed anus) underwent Anterior Sagittal Anorectoplasty (ASARP) procedure. Out of 21 patients, 9 had poor voluntary bowel movement (42.87%), 7 had constipation (33.3%) and 5 patients presented with soiling (23.80%). Abnormal local finding on pelvic MRI was seen in 16 patients (76.19%) in the form of misplaced neorectum, hypoplastic muscle complex, perianal fat or abnormal anorectal angle and 7 patients had bony abnormalities or cord anomalies. CONCLUSIONS MRI is a useful modality in operated children of ARM with poor outcomes of continence. Local abnormalities are more common in children under going abdomino-perineal pull through than PSARP.

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“…MRI study is considered to provide a valuable postoperative assessment of anorectal pull-through procedures because it allows visualization of the SMC in relation to its thickness or misposition [20][21][22][23]. Advantages of MRI include an excellent inherent soft-tissue contrast enhancement, multiplanar imaging capabilities and lack of ionizing radiation; disadvantages include cost and the relatively frequent need for sedation, that can be avoided in cooperative children using fast imaging sequences.…”

Section: Discussionmentioning

confidence: 99%

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

Caruso

Catalano

Voti

et al. 2015

Journal of Pediatric Surgery

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Postoperative Pelvic MRI of Anorectal Malformations

Abstract: Pelvic MRI is a valuable tool in the assessment of postoperative anorectal malformations that may necessitate additional surgery.

Cited by 30 publications

References 8 publications

Magnetic Resonance Evaluation of Anorectal Malformation Cases Treated by Posterior Sagittal Anorectoplasty

Magnetic Resonance Evaluation of Anorectal Malformation Cases Treated by Posterior Sagittal Anorectoplasty

Functional Co-Relation Between Operated Cases of Anorectal Malformation and Post-Operative Pelvic Mri

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

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